Science of Clinical Investigation Training Program 2016-17 Academic Year Graduate Training Programs in Clinical Investigation Instructions: Complete and fax (410) 955-9933 or email this form to Stacey Marks ([email protected]). Payment can be made by calling 410-502-8053; Checks can be mailed to: JHSPH 615 N. Wolfe Street, Suite W1101, Baltimore, Maryland Please Allow 5-7 days for your registration to be processed. Once you are officially registered, you will receive an email containing a Johns Hopkins Enterprise Directory (JHED) Log-in ID (LID) and instructions for creating a password. You will then be directed to log in to ISIS (https://isis.jhu.edu/ sswf). Access to ISIS allows you to view registrations, charges, payments and update personal data, etc. Professional Category: First Name: Middle Initial: Professional Code 2: Professional Code: SSN / Student ID: Please enter the corresponding number(s) in the spaces provided above. Citizenship: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Visa Type: Permanent resident of: Street Address: Street Address 2: City: Zip: State: Country: If Maryland, specify County: Phone Number: Email: Accountant Audiologist Biologist Biochemist Biostatistician Clergy Clinical Health Worker Dietician Dental Hygienist Dentist Economist Engineer Environmental Scientist Epidemiologist Health Educator Health Services Admin Hospital Clinician Information System Specialist 19 Journalist 20 Chemist 21 Lawyer 22 Mathematician 23 Medical Student 24 Microbiologist 25 Nurse 26 Occupational Therapist 27 Optometrist 28 Pharmacist 29 Physician 30 Physicist 31 Physiologist 32 Psychologist 33 Podiatrist 34 Social Scientist 35 Teacher 36 Veterinarian 37 Not Specified/Other Male & Registration: Year 15-16 Term: Option Credits TUITION CHARGES Tuition Rate is $1055 per credit for 2016-17 Non Credit Credit Audit Is this an online course? Total Credits: Discover Visa Check 410-502-6965 Credit = Total Amount: Signature: All courses taken for the SOCI Training Program are taken Non Credit and Pass/Fail. To view the Pass/Fail policy, please visit http://jhsph.edu/student_affairs/registrar/passfail.html Date: P/F
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